Cherry Tree Lodge Private Retirement Home Limited

Cherry Tree Lodge provides accommodation, personal care and support for up to 31 older people in one adapted building. At the time of the inspection there were 12 living at the home.

People’s experience of using the service and what we found

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People's experience of using the service was positive. People received the care and support they needed when required. The feedback we received showed staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

People felt safe living at Cherry Tree Lodge. We were told, “Staff are very good, they work very hard.” Another person responded when asked, “Yes, I feel safe here.”

People reported good support regarding the management of their medicines and told us they got their medicines on time. The medications records we saw were clear and in line with best practice. Staff had been trained and underwent competency checks by the registered manager.

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records identified risks clearly and there were plans in place to help keep people safe.

The service had two registered managers. Following discussion and previous enforcement action taken by the Care Quality Commission, the management arrangements were being reviewed to include only one registered manager. The RM we liaised with was providing effective leadership and was supported by senior care staff.

Rating at last inspection and update

At the last full comprehensive inspection the service was rated Good (report published 26 March 2019). Since then we have inspected the service on two separate occasions; these were targeted inspections and the service was not rated.

Why we inspected

The inspection was prompted in part due to concerns received about aspects of the overall management of the home including the management of infection control with respect to COVID-19. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cherry Tree Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cherry Tree Lodge provides accommodation, personal care and support for up to 31 older people in one adapted building. At the time of the inspection there were 18 people in residence.

People’s experience of using this service

At our last inspection we found breaches of regulations because the provider was failing to manage policy and practice related to infection control; specifically, the response to Covid-19. The restrictive nature of the providers response to Covid-19 had raised further issues and breaches of regulation around the home’s admission procedures, compliance with the Mental Capacity Act (MCA) 2005 and Human Rights issues.

Enough improvement had been made at this inspection and the provider was no longer in breach of Regulations.

People we spoke with and their relatives told us they felt safe in the home and liked living there. People were relaxed and told us staff supported them well. One relative commented. “I can’t fault them. Really good. Cherry tree is very homely, and staff are very kind.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. This was an improvement from the last inspection.

Arrangements were in place for checking the environment to ensure it was safe in relation to infection control and the threat of Covid-19. We found the policies and procedures in place had been developed and improved since the last inspection and were following current national guidance; for example, with regard to personal protective equipment (PPE) and testing for Covid-19.

We found a positive attitude from managers who were much more open and accessible to external advice from professional and regulatory bodies. The information shared by the provider and managers in their communications to people and relatives had improved and was consistent in following best practice guidelines.

People felt the care staff had the skills and approach needed to help ensure they were receiving the right care. Staff we spoke with felt, overall, they had been supported by the managers at the home and they enjoyed working at Cherry Tree Lodge.

Rating at last inspection:

The last rating for this service was Good (published 26 March 2019).

We did, however, carry out a targeted inspection on 23 June 2020 to follow up on specific concerns, where we did not rate the service. There were multiple breaches of regulation and we took enforcement action and told the provider to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

We undertook this targeted inspection to check whether the enforcement action we previously took in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous comprehensive inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service

Most people we spoke with and relatives told us they felt safe in the home and liked living there. There were, however, two examples of safeguarding concerns were people’s basic human rights had not been upheld and people had not been treated with dignity and respect.

Within the context of the Covid-19 infection risk, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

Arrangements were in place for checking the environment to ensure it was safe in relation to infection control and the threat of Covid-19. We found the policies and procedures in place were not always following current national guidance; for example, with regard to personal protective equipment (PPE) and testing for Covid-19.

We found the provider had a series of policies and procedures in place to manage the threat of Covid-19. These had not been changed or developed in the context of ongoing government updates around best practice and guidance. We found a negative attitude from managers and a reluctance to be open and accessible to external advice from professional and regulatory bodies. Some of the information given by the provider and managers in their communications to people and relatives had been incorrect or misleading.

There had been management and staffing changes since the last inspection, however, the home was staffed appropriately and most staff we spoke with had been employed for several years and this helped to develop positive relationships with people living there. People felt the care staff had the skills and approach needed to help ensure they were receiving the right care. Staff we spoke with felt, overall, they had been supported by the managers at the home and they enjoyed working at Cherry Tree Lodge.

Rating at last inspection:

The last rating for this service was Good (published 26 March 2019).

Why we inspected:

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks. We had concerns about the way the provider was managing policy and practice related to infection control; specifically, the response to Covid-19. The restrictive nature of the providers response to Covid-19 had raised issues around the home’s admission procedures, compliance with the Mental Capacity Act 2005 and Human Rights issues.

These were discussed with the provider’s management team at an Emergency Support Framework (ESF) call with the Care Quality Commission on 29 May 2020. The assessment highlighted the home ‘requiring support’ due to a failure to adhere or consider infection control guidance during the pandemic.

The Care Quality Commission have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement:

We are mindful of the impact of the Covid19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people's consent to care, people’s privacy and dignity, risk around the management of Covid-19 including the overall management and governance of the home.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Cherry Tree Lodge provides accommodation, personal care and support for up to 31 older people. At the time of the inspection there were 27 people resident.

People’s experience of using this service:

There was a positive atmosphere in the home which we found to be homily and well run. People living in the home interacted freely and staff were seen to be caring and supportive.

The assessment and planning of people’s care was individualised. We found care records that supported people were completed and reviewed with the person’s input. We found some of the detail could be improved to give a fuller picture of the care being given.

We saw there were systems in place to monitor medication so that people received their medicines safely. We found some of the medication records did not fully meet the provider’s own standards; this was addressed during the inspection.

We were given positive feedback from the people we spoke with who were living at Cherry Tree Lodge. They told us they enjoyed living at the home and their quality of life was enhanced by the care provided and the general running of the home. People said they were well cared for. People were listened to. People had the support they needed to express their needs and wishes. People could make decisions and choices.

All the people we spoke with told us they felt safe and well supported. One person said, “The carers are lovely, every one of them." A visitor commented, “The carers are excellent, nothing is too much trouble for them."

The home was staffed appropriately and consistently. We found staff communicated and supported people with dignity and respect. Staff could explain each person’s care needs and how they communicated these needs. People living at Cherry Tree Lodge told us that staff had the skills and approach needed to ensure people were receiving the right care.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

We saw people’s dietary needs were managed with reference to individual needs and choice. Meal times were a main feature of life in the home and provided a very good social occasion.

The manager could evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were generally effective in managing the home and were based on getting feedback from the people living there. Some of the auditing processes needed to be completed so that there was a better collation and analysis of feedback received which could then plan ongoing development.

Rating at last inspection:

This service had previously been inspected in October 2016 and rated as good. The report was published on 2 November 2016.

Why we inspected:

This was a planned comprehensive inspection. There were no previous concerns about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Cherry Tree Lodge is registered to provide accommodation and personal care for up to 31 older people. It is situated on the outskirts of Southport. There are 25 single and 3 shared bed rooms, all rooms have en-suite facilities.

We observed staff interacting with people and found there were enough staff available to meet people’s needs in a timely manner. People we spoke with said there were always staff available both night and day. Staff we spoke with told us they worked well as a team.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We found an error with disposal of controlled drugs but this was rectified immediately by the provider.

We spoke with staff about the training and support they received. All staff we spoke with told us they received appropriate training which gave them the skills and knowledge to carry out their role.

Staff we spoke with were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and told us they had received training in this area.

People received food and nutrition in line with their individual preferences. Snacks and drinks were available throughout the day in addition to meals provided.

We spent time throughout the inspection observing staff interacting with people who used the service. We found staff were patient, kind and caring and understood the different needs of people that were supporting.

Training was provided to staff to ensure they were kept up to date with their knowledge. Staff felt training provided them with the skills to do their job well.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff confirmed they had received training in this area and were knowledgeable about consent to care.

People received a nutritious and balanced diet which met their needs and maintained their preferences. People were offered drinks and snack throughout the day in addition to their meals.

Staff showed kindness and understanding in their interactions with people who used the service. They took time to ensure people’s choices were respected. Staff knew people well and was able to support them in line with their individual preferences.

We looked at care plans belonging to people and found they reflected the care and support being provided.

Activities and social events took place and were enjoyed by people who used the service. People were involved in what they would like to do and the activity co-ordinator would arrange events.

The provider had a complaints procedure and people knew how to raise a concern. Everyone we spoke with were very happy and had no complaints about the service.

There were systems in place to assess if the home was operating correctly. Action plans had been put in place to address any areas that needed improving.

An adult social care Inspector carried out this inspection. We spoke with three people using the service, three staff and the registered manager. We looked at risk assessments and care plans for one person. We looked at policy and procedure documents relevant to involving people and consent to care and treatment.

During this inspection on 18th of February 2015 we found improvements had taken place in that the managers and staff understood the need to seek consent from people or hold a best interests meeting if a person lacked the capacity to make a decision. Staff understood the correct steps to take if relatives requested installing surveillance cameras in future.

' Is the service safe?

' Is the service effective?

' Is the service caring?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records. We also spoke with a representative of the provider [owner] of the home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at the homes understanding of the Mental Capacity Act 2005 [MCA] which is the legislative framework for the decision making process regarding people who may lack mental capacity to make such decisions.

Prior to the inspection we received some information that the home had introduced some equipment to help monitor a person's behaviour. We checked to see how this had been introduced and whether the person had been involved in the decision and how this impacted on their privacy.

We found the introduction of this equipment /procedure had infringed the person's right to privacy and had not complied with the law. We have asked the provider to take action regarding this.

Staff advised us that one person was subject to a Deprivation of Liberty Safeguards (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. In this instance the home had acted in accordance with DoLS and had protected the person by ensuring their rights.

Those people spoken with were very relaxed around staff and said they were listened to, so any concerns could be addressed. This helped ensure people had good feelings of wellbeing and felt safe.

We spoke with staff on the day of our visit who were able to tell us how they would identify possible abuse and how they would report this through the senior staff in the home.

Is the service effective?

People's health and care needs were assessed with appropriate referrals being made to external professionals who could assess and support the care of people in the home. Care needs had been identified in care plans and these had been reviewed. We looked at the care of three people and the care plans reflected their current needs.

Visitors confirmed that they were able to see people at any time as visiting times were flexible. They said that staff kept them informed and they were therefore always up to date with any changes to people's care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented positively about life in the home and about the staff providing the care. A relative we spoke with was very impressed with the care. They said they felt involved in the care and staff were quick to respond to any changing care needs their relative might experience.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People living in the home spoke positively about the care they received. Comments included, 'The food is excellent and I am well looked after. I can come and go around the home as I wish.' A relative we spoke with told us, 'Staff keep us [the family ] up to date and contact us if there are any concerns. We feel confident they are well looked after and safe."

The home had a detailed handover report for staff at shift changeover time. This included a colour coded system whereby people with high levels of need or new concerns were easily identified. Staff we spoke with told us this system helped them carry out their job and was a useful visual summary of people's needs.

Care plans we looked at included details regarding which medication people would manage independently and which they required support with.

People we spoke with told us that staffing levels were good and that they did not have to wait long for call bells to be answered if they needed assistance in the lounge areas or in their own rooms during the day or in the night.

We found that personnel, supervision and training records were kept securely in order to ensure the confidentiality of information held by the home.